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Questions and Answers
What is a common effect of radiation therapy that affects the patient's skin?
Which symptom indicates a possible toxicity increase when chemotherapy is administered concurrently with radiation therapy?
What precaution should a nurse take when a patient has a radioactive implant?
Which of the following is important for maintaining oral health during radiation therapy?
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What is the recommended action if a patient exhibits fatigue and malaise during radiation treatment?
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What is one reason why scientists face challenges in targeting malignant and immune cells uniquely?
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In which setting can chemotherapy agents be administered?
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What is a common side effect associated with antitumor antibiotics?
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Which mechanism of action do plant alkaloids employ in cancer treatment?
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What should be done if extravasation is suspected during the administration of a vesicant?
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What side effect is commonly associated with hormonal agents in chemotherapy?
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What is a potential risk when administering vesicants intravenously?
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Which of the following is NOT a route of chemotherapy administration?
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What is the primary purpose of the nurse's education and emotional support for patients and families?
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What should guide the nurse's response when patients or their families inquire about diagnostic test results?
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Which of the following is NOT a postoperative complication that nurses should monitor for?
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During which phases of the cell cycle are cells most vulnerable to the effects of radiation?
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Which body tissues are considered most sensitive to radiation therapy?
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What is the function of ionizing radiation in cancer treatment?
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What defines a radiosensitive tumor?
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Which type of radiation therapy uses X-rays to target cancerous cells?
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What is the primary purpose of cryoablation in prostate cancer treatment?
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What temperature is the prostate frozen to during cryoablation?
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What temporary condition might most patients experience after undergoing cryosurgery?
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What is one advantage of cryoablation compared to traditional prostate cancer treatments?
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What does chemosurgery primarily treat?
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What are the primary beams used in stereotactic radiosurgery?
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Which of the following describes a disadvantage of cryosurgery?
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What is the aim of chemical peels in chemosurgery?
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What is the primary goal of surgical treatment for cancer?
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Which of the following indicates a more malignant tumor based on grading?
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What does the 'N' in the TNM staging system represent?
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Which type of biopsy involves the complete removal of a tumor and some surrounding tissue?
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What is the purpose of primary prevention in cancer management?
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Stereotactic radiosurgery is known for providing which of the following?
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What aspect of cancer does secondary prevention focus on?
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Which type of surgery aims to remove the primary tumor along with lymph nodes and adjacent structures?
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Which cancer management strategy focuses on symptom relief rather than eradication?
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Which component is not evaluated during testing for suspected cancer?
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Which treatment employs electrical current to destroy tumor cells?
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What is a common psychological response of patients undergoing extensive cancer testing?
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Which term describes substances produced by tumors that impair immune responses?
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Study Notes
Tumor Antigen - Antibody Complexes
- Immune system may be suppressed through the production of tumor antigen - antibody complexes.
- Tumors can change their appearance and produce substances that impair typical immune responses.
- These substances can promote tumor growth and increase the patient’s susceptibility to infection.
Detection and Prevention of Cancer
- Primary Prevention
- Educate the community about knowledge and skills for preventing cancer.
- Assist patients in avoiding known carcinogens.
- Encourage dietary and lifestyle changes.
- Secondary Prevention
- Promote genetic screening and cancer risk evaluation.
- Raise public awareness about health-promoting behaviors, including Pap smears, breast and testicular examinations, and digital rectal examinations.
Diagnosis and related Nursing Considerations
- Patients suspected of having cancer undergo extensive testing to
- Determine the presence and extent of the tumor.
- Identify possible metastasis or invasion of other tissues.
- Evaluate the function of involved and uninvolved body systems and organs.
- Obtain tissue and cells for analysis including evaluation of tumor stage and grade.
- Patients may experience fear and anxiety during extensive testing and upon receiving results.
- Nurses can alleviate fear and anxiety by explaining:
- The tests to be performed.
- Sensations likely to be experienced.
- The patient’s role in the test procedures.
Tumor Staging
- Staging determines the extent of the tumor and existence of metastasis.
- The TNM system is frequently used:
- T: Primary tumor extent
- N: Lymph node involvement
- M: Extent of metastasis
- TNM system:
- Tumor (T):
- T1 = 4cm
- T4 = Invades the adjacent and deep subjacent area.
- Nodes (N):
- N0 = None
- N1 = Ipsilateral (same side)
- N2 = Contralateral/bilateral
- N3 = Fixed palpable
- Metastasis (M):
- M0 = None
- M1 = Distant M
- If N and M are absent, the stage is determined by the T:
-
- Stage 1 * Stage 4 ïƒ T1 N0 ïƒ T1 N2 M0 M0 ïƒ T2 N2 M0
-
- Stage 2 ïƒ T3 N2 M0 M0 ïƒ T2 N0 ïƒ T1 N3 M0
-
- Stage 3 ïƒ T3 N3 M0 M0 ïƒ T2 N3 M0 N0M0 ïƒ T3 ïƒ T4 N0 M0 N0M0
-
- Tumor (T):
Tumor Grading
- Classifies tumor cells.
- Less differentiated cells are more malignant.
- Grade 1: 75-100% well differentiated (best prognosis).
- Grade 2: 50-75%.
- Grade 3: 25-50%.
- Grade 4: 0-25% (most malignant), poorly differentiated.
Management of Cancer
- Cure: Complete eradication of malignant disease.
- Control: Prolonged survival and containment of cancer cell growth.
- Palliation: Relief of symptoms associated with the disease.
Management of Cancer (7)
- Surgery
- Radiation therapy
- Chemotherapy
- Bone Marrow Transplant
- Biologic Response Modifier Therapy
- Photodynamic therapy
- Gene therapy
Surgery
- Surgical removal of the entire cancer is the ideal and most frequently used method.
- Two Types:
- Diagnostic surgery
- Surgery as Primary Treatment
Diagnostic Surgery
- biopsy
- Usually performed to obtain a tissue sample for analysis of suspected malignant cells.
Types of Biopsy
- Excisional: Removal of the entire tumor and surrounding tissues.
- Incisional: Removal of a wedge of tissue from the tumor.
- Needle: A small amount of tissue is aspirated through a needle guided into the suspected area.
Surgery as Primary Treatment
- Goal is to remove the entire tumor or as much as possible, including involved tissues and lymph nodes.
- Local excision: Removal of small mass and a small margin of surrounding tissue.
- Radical excision: en bloc removal of the primary tumor, lymph nodes, adjacent structures, and surrounding tissues.
- Salvage surgery: Extensive surgical approach to treat local recurrence after a less extensive primary approach.
Other Surgical Interventions
- Electrosurgery: Uses electrical current to destroy tumor cells.
- Cryosurgery: Uses liquid nitrogen to freeze and destroy tissue.
- Chemosurgery: Combined chemotherapy and surgical removal of tissue.
- Laser surgery: Uses light and energy to vaporize cancer cells.
- Stereotactic radiosurgery (SRS): Single, precise administration of high-dose radiation therapy.
Laparoscopic Electrosurgery
- Minimally invasive surgery using optical and surgical instruments through small incisions.
- Limited field of vision may cause undetected burns outside the surgeon's view, potentially leading to infection.
Cryosurgery
- Treatment for prostate cancer using cryoprobes inserted into the prostate gland.
- Probes are precisely placed using ultrasound guidance, and temperature sensors are used to ensure tissue freezing.
- Procedure is performed under spinal anesthesia.
Advantages of Cryosurgery for Prostate Cancer
- Minimally invasive procedure.
- Favorable success rate and complication rates.
- Short recuperation period.
- Repeatable if the first cryoablation fails.
- Radiation therapy or prostatectomy is still an option if the procedure fails.
- Less expensive than traditional treatment.
Disadvantages of Cryosurgery for Prostate Cancer
- Suprapubic urinary catheter for 2-3 weeks after the procedure.
- Initial impotence after the procedure, which may improve over time.
Chemosurgery
- Also called chemical peels.
- Uses a chemical solution to remove damaged skin.
- Helps restore wrinkled, sun-damaged, and blemished skin.
Stereotactic Radiosurgery
- Non-surgical treatment using focused beams of radiation on small, deep tumors or lesions.
Nursing Management in Cancer Surgery
- Respond to patient and family questions about diagnostic testing results based on physician information.
- Provide education and emotional support by assessing patient and family needs and exploring their fears and coping mechanisms.
- Encourage active participation in decision-making when possible.
- Monitor post-operative responses for complications such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid/electrolyte imbalance, and organ dysfunction.
- Provide comfort measures.
- Provide post-operative teaching related to:
- Wound care
- Activity
- Nutrition
- Medication information
- Plan for discharge, follow-up, home care, and treatment for continuity of care.
Radiation Therapy
- Uses ionizing radiation to interrupt cellular growth.
- Used to:
- Control malignant disease when a tumor can’t be removed surgically.
- Treat local nodal metastasis.
- Prevent leukemic infiltration into the brain or spinal cord.
- Cells are most vulnerable to radiation during DNA synthesis and mitosis.
- Tissues with frequent cell division are most sensitive:
- Bone marrow
- Lymphatic tissue
- Epithelium of the GI tract
- Hair cells
- Gonads
- Radiosensitive tumor: Can be destroyed by a dose of radiation that still allows for cell regeneration in normal tissue.
Types of Radiation Therapy
- External radiation: X-rays used to destroy cells at the skin surface or deeper in the body. High energy for deeper penetration.
- Internal radiation: Radioactive isotope inserted into applicators for a prescribed period.
Radiation Therapy Toxicity
- Increased when concurrent chemotherapy is administered.
- Altered skin integrity is common:
- Alopecia
- Erythema
- Desquamation
- Xerostomia
- Loss of taste
- Dysphagia
- Thrombocytopenia
- Leukopenia
- Fatigue, malaise, anorexia
Nursing Management in Radiation Therapy
- Explain the procedure, equipment, duration, immobilization needs, and absence of sensation during the procedure.
- If radioactive implants are used, inform the patient and family about visitor and personnel restrictions and other radiation procedures.
Protecting the Skin & Oral Mucosa
- Assess patient’s skin, nutritional status, and well-being.
- Monitor skin and oral mucosa frequently for changes.
- Protect the skin from irritation and instruct the patient to avoid using ointments, lotions, or powders on the area.
- Ensure gentle oral hygiene to remove debris, prevent irritation, and promote healing.
- Offer reassurance by explaining that symptoms are a result of treatment and do not indicate disease progression.
Safety Precautions for Radiation Exposure
- Patient should be in a private room.
Chemotherapy
- Scientists have yet to identify features of malignant and immune cells that make them uniquely targetable.
- Hair growth and intestinal epithelium are severely affected.
- Causes fear due to potential severe side effects.
- Used when cancer has metastasized. Treats systemic disease rather than localized lesions.
- Often used in combination treatments
- Can be administered in a hospital, clinic, or home setting.
- Routes:
- Topical, oral
- IV, IM, SQ
- Arterial, intracavitary, intrathecal
Special Problems with Chemotherapy
- Extravasation:
- Special care is needed when administering vesicants intravenously.
- Vesicants cause tissue necrosis if deposited into the subcutaneous tissue.
- Only trained physicians and nurses should administer vesicants.
- If extravasation is suspected, stop administration, apply ice (unless the vesicant is a vinca alkaloid), aspirate the vesicant, and inject a neutralizing solution.
Classification of Chemotherapeutic Agents
-
Antitumor Antibiotics
- Interfere with DNA synthesis by binding DNA.
- Prevent RNA synthesis.
- Common side effects: BM suppression, nausea, vomiting, alopecia, anorexia, cardiac toxicity.
-
Mitotic Spindle Poisons
- Plant Alkaloids
- Arrest metaphase by inhibiting mitotic tubular formation.
- Common side effects: BM suppression, neuropathies, stomatitis.
- Taxanes
- Arrest metaphase by inhibiting tubulin depolymerization.
- Common side effects: Bradycardia, hypersensitivity, BM suppression, alopecia, neuropathies.
- Plant Alkaloids
-
Hormonal Agents
- Bind to hormone receptor sites that alter cellular growth.
- Block binding of estrogens to receptors and inhibit RNA synthesis.
- Common side effects: Hypercalcemia, jaundice, increased appetite, masculinization, feminization, sodium/fluid retention, nausea, vomiting, vaginal dryness, hot flashes.
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Description
Test your knowledge on the common effects of radiation therapy, including skin reactions and oral health maintenance. This quiz also covers nursing precautions with radioactive implants and managing symptoms when chemotherapy is combined with radiation. Perfect for nursing students and healthcare professionals.
